Healthcare Provider Details

I. General information

NPI: 1073579637
Provider Name (Legal Business Name): BECKIE M GRGICH PSYD, PSY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14960 WOODCARVER RD
COLORADO SPRINGS CO
80921-2370
US

IV. Provider business mailing address

PO BOX 3392
MONUMENT CO
80132-3392
US

V. Phone/Fax

Practice location:
  • Phone: 193-448-7797
  • Fax: 193-139-2107
Mailing address:
  • Phone: 719-344-8779
  • Fax: 719-313-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4845018-2501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP40413
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6176
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3041
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: